Lower Blepharoplasty

Lower Eyelid Surgery

The lower eyelids are a complex structure. They work against gravity and unfortunately, the integral strength of the eyelid reduces as we age which leads to a lack of natural support.

As the lower eyelid ages, the skin can become saggy and loose. Ageing skin also loses the ability to bounce back to being flat after movement is lost, therefore muscle action is more likely to leave permanent lines that manifest themselves as ‘crows feet’.

In order to address the loose and sagging skin of the undereye area, a lower blepharoplasty surgical procedure may be necessary.



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  • What is a lower lid blepharoplasty procedure?

    Lower blepharoplasty is a surgical procedure performed to improve the appearance of sagging, loose skin of the undereye area by removing redundant skin without undermining.

    Where required, lower blepharoplasty may be combined with fat redrape to reposition fatty bulges. Because the fat redrape technique involves deeper level surgery, recovery time is significantly extended.

  • How does the lower eye area change as we age?

    As we age, eyelid skin frequently becomes a concern prompting people to consider treatment to relieve heaviness and alleviate a tired appearance. To understand why these changes develop, we need to have an understanding of the anatomy of the eyelid area and understand the ageing process.

    The prime role of the eyelids is to protect the eye to ensure that the cornea remains hydrated and provides a physical barrier to injury. As we age the brow falls a little allowing more skin to sit in the upper eyelid. This increases the overhanging skin fold and may give a sensation of heaviness. The quality of the skin changes also leading to crepey texture within the eyelid. The increased fold may therefore look cluttered and lose its sharpness. Fat may be apparent in the corners of the upper eyelid.

    The lower eyelids are a more complex structure. They work against gravity and unfortunately the integral strength of the eyelid reduces as we age, leading to a lack of natural support. As the lower eyelid ages, it often leads to skin which is saggy and loose. This can lead to permanent lines around the eyes that are often known as “crows feet”.

    Fat that is naturally present around the eye is kept in place by a structure called the orbital septum. As we age, the orbital septum becomes lax, allowing the fat to prolapse forwards. This gives the characteristic puffiness that commonly occurs with advancing age. With the above changes, the junction between the eyelid and the cheek falls, leading to hollow lines appearing. This gives the illusion of the eye becoming smaller.

    In assessing the eyelids, we therefore need to assess the following-

    • Brow position
    • Skin excess and quality
    • Muscle action
    • Fat prolapse
    • Natural lid tone.
  • How is the lower blepharoplasty procedure carried out?

    A detailed consultation with a consultant plastic surgeon is essential prior to undergoing any procedure of this nature, including a lower lid blepharoplasty. During the consultation, your surgeon will discuss any problem areas, desired improvements, options available (including no treatment at all) and expected outcomes.

    Should a lower blepharoplasty be agreed upon as the most suitable treatment, the procedure will be carried out by your surgeon in our newly refurbished operating theatre.

    Depending on preference, the surgery may be performed under either a local or a general anaesthetic. The skin is gently cleansed and the eyelid carefully marked, noting areas of fat bulging and skin excess. The incision is usually placed just below the eyelash line to help hide the resultant fine scar in a natural line. The skin is carefully lifted and any fat recontoured to improve the smoothness of the lower lid. After removing a small strip of excess skin and muscle, the wounds are carefully closed using very fine stitches.

  • How does the lower lid blepharoplasty procedure feel?

    Depending on preference, the surgery may be performed under either a local or general anaesthetic to ensure the client’s total comfort for the duration of the procedure.

  • After lower lid blepharoplasty, will all the smile lines be cleared and will those bands that appear when I smile go?

    Unfortunately not. The lines are due to muscle action and while we can reduce the muscle we cannot remove it all together. If we did, then the lid would be very floppy and droop. A better alternative is to use Botulinum Toxin to selectively relax the muscle fibres and soften the laughter lines safely.

  • I have dark lines under my eyes, will these go after lower lid blepharoplasty surgery?

    It depends on the cause of the darkness. If the darkness is caused by shadows cast by bulging fat then recontouring the fat will help. However, if it is due to the skin being very thin and dark in colour then this will more than likely persist after surgery.

  • My beautician says I have malar bags - will these disappear after lower blepharoplasty?

    Malar bags or festoons are notoriously diffcult to treat and will not improve with standard lower blepharoplasty. They may be improved with a mid facial lift.

  • What pre and post-procedure advice must I follow?


    We are governed by CQC guidelines which state a consultation must be carried out prior to any surgical appointment being booked. The consultation must be conducted at least 2 weeks before, but not more than 4 months prior to the surgery.

    Contact lenses should be removed prior to arrival at the clinic in anticipation of your lower blepharoplasty.


    Patients should not drive for 24 hours post-procedure, therefore arrangements for a taxi or driver should be made.

    After surgery, it is essential that you rest and avoid any vigorous exercise or activities that may increase blood pressure and delay healing. Mild swelling and some bruising are to be expected after this surgery. These side effects reach a maximum after 24-48 hours. They will usually fade by the 10th postoperative day. Some minor bruising and swelling may persist after three weeks but this may be easily disguised with the careful application of a concealer, if you wish to do so.

    The fine stitches are removed after one week and specific instructions given on massage and muscle exercises.


Lower Eyelid

Anaesthetic Type

Application of local or general anaesthetic at the treatment site ensures total comfort for the duration of the procedure

Procedure Time

120 minutes


The skin is carefully lifted and any fat recontoured to improve the smoothness of the lower lid. After removing a small strip of excess skin and muscle the  wound are carefully closed using very fine stitches


Once the suture is removed one week after the procedure, patients should expect to see the true result of the procedure


Patients are advised to treat day 1 post-op as a rest day, refraining from exercise for 14 days. Bruising should be expected for around 7 days after the procedure.


Excess skin is permanently removed



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